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Sublime

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  1. As others have said that looks like A-Fib w/ RVR. And yes... that is technically a form of SVT. SVT = Supra-ventricluar tachycardia. Meaning that the tachycardia is coming from ABOVE the ventricles. So any tachycardic rhythm that originates above the ventricles is an SVT. The term SVT is most often used because many times the rhythm is too fast to discern what the underlying rhythm is.
  2. I will be writing and submitting mine tomorrow! Last minute I know but I will have it done, so keep an eye out.
  3. My college offers an Associate's in Applied Science for EMS. I went ahead and took the courses for this degree because there weren't that many and I needed most of them for nursing pre-reqs anyways. I am going to get a BS in nursing eventually, though I am in no rush because I like my job as a paramedic. Most degree's really don't help you much as a paramedic though. I am not discouraging you to get one because I feel like our profession will never progress if we don't have more education. I am just saying, for most people in EMS that get / have a degree have no benefits over those who don't. For that reason, I'd go with a degree that is not focused solely on EMS. For instance if I wasn't going for a BSN I would probably consider a BS in biology or something of that sort. That way if you ever want to progress to another position in the healthcare field, you have a more useful degree. That's just my feelings on it. However if you really want that degree in literature I'm sure you could put it to use as a paramedic. There are EMS magazines and websites that could probably use talented writers, you could even use your knowledge to write your own book ect. So don't discredit the degree you want because you think a degree focused in ems will let you progress farther, because it likely won't.
  4. I will be writing an essay soon! Expect at least 1 more submission in the next week or two!
  5. http://captainchairconfessions.com/2012/09/14/sick-dude-part-ii/ There a link to a nice follow up on this case. Has lab values and everything. This patient did have hyperkalemia that was secondary to renal failure. He was also on an oral K+ supplement that was not mentioned in the first post. Definitely and interesting case.
  6. Just saw this case through a facebook post. Would like to hear opinions on interpretation, causes, and treatment. http://captainchairconfessions.com/2012/09/10/sick-dude/ To me it looks like Hyperkalemia (Flat / non-existent P-Wave, bizarre/widened QRS morphology). However I would suspect with all the vomiting and diarrhea that it would be low. I would also suspect him to be tachycardic in his situation, but then again he is on a beta blocker. So I am second guessing myself here. What do you guys think?
  7. No I am not new, been at the hospital a year. If a future situation like this comes up I will check the BP myself before going to report it to someone else. I don't know the patients history. In my short trip with her she didn't complain of a bad headache, pressure behind the eyes, or dizziness. She was breathing fine. No assessment was done on her besides the BP, but she did seem asymtomatic, but then again I can't really say that because I didn't assess her myself. Guess I will let it go. I could say something to my manager, maybe, I just don't like how they handled it. I am sure the patient was listening, and does she now think she is not hypertensive when she has a BP of 180+? Our relationship with the ER isn't that great to begin with, so I really wouldn't be damaging our relationship much if I made a deal out of it. The thing is that I was considering going down there to work, which is partly why I kept my mouth shut. But I don't think those are the people I want to work with. I'll keep applying for positions on a box.
  8. I currently work a tech in the county hospital. The unit I work in is a med/surg - Telemetry mixed unit. We also do outpatient procedures such as blood/plasma infusions. Today we had an infusion patient who came in to get an iron infusion. I was asked by the nurse to take the patient to the urgent care clinic down stairs due to a BP of 220 systolic (not sure of diastolic, but if was around 80-90 if I remember correctly). The patient had already recieved her infusion. Apparently this was per request of one of the hosptial physicians, that the patient be taken down to the ER/Urgent care clinic (these people are classified as outpatient, so in a situation like this we can't treat them like a normal patient who is admitted to our unit, they have to start from the beginning and get admitted first, its stupid but thats how it is) Our urgent care clinic does not deal with BP's that high, and would of sent them to the ER, so I went ahead took the patient straight to our ER. When I get to the triage area, a nurse asks me where I am from so I tell her and explain the situation. The nurse instructs the tech (who is a paramedic) to take a BP. She does it with a machine and it reads 188/78. She then looks at the nurse who is right next to me and says "It's normal". The nurse see's the BP also, and starts to get an attitude with me. She says "Did you get a manual BP of 220? I thought you said it was higher, whats the number to where your from?". I give her number to the nurse upstairs where the pt. came from and told her I did not witness the BP being taken upstairs. The ER triage nurse (who I believe is the ER Charge nurse), tells my nurse that the pt. is not hypertensive. She then calls the doctor that requested the patient be sent to the ER/Urgent care and told him "Yeah well we have the patient down here for an apparent hypertensive crisis, but the thing is she's not hypertensive at all." That was her exact words. At this point I was pretty pissed but I bit my tongue and didn't say anything because it would of resulted in a argument in front of the patient. I was told by the ER nurse I could leave while she waited on the doctor to call her back. I feel like I should have said something to the ER Nurse / Tech. I just keep thinking what if the doc sends her home under the impression she didn't have a high BP and something happens. I will probably never know anyway but its bugging me. Wish I would of atleast spoken up for her. We do have an incredibly busy ER. It is not uncommon to have patients all over the walls, and really long wait times to get a bed, but I don't believe its an excuse. Instead I told my charge nurse when she got back, and talked to the patients nurse about it. Both of them disagreed with the ER nurse about this, but nothing will be done about it. What do you think I should do? Let it go? Should I go to my manager and talk to him about it? What would you have done in my situation? Thanks for the advice!
  9. I have a medic job interview with a major service in my area on feb. 8th. I already was (and still am) working a steady full time position when I applied for this position a little over a week ago. The ordeal is that I have a planned vacation that is paid for towards the end of march. If I'm offered a position is it fair / reasonable for me to ask of I can start when I get back? I know this service has a very strict orientation/training process, so I don't know how accepting they will be to that. What would you do? Rejecting the position if it is offered would not be an option, I really want the job, but don't want to throw away our vacation either. Thanks
  10. Thanks systemet, although your explanation was very good, as I am a more visual learner so I still don't have a grasp on it. But with the resources in the links you provided, I think I can figure it out eventually. A lot of information on that EB Medicine site, unfortunately I don't have the time to read it all right now. I found some more resources after reading your reply, and I figured i'd post them in case anyone else was curious about axis deviation. Video explanation by a DR on axis deviation This sight has a frontal axis tutorial as well. http://www.blaufuss.org/ Thanks again for your help.
  11. I would just try 10-12 LPM w/ a pedi non-rebreather. Try and find out what the childs normal 02 sat is (obviously it will be low) and titrate the 02 to that. If the child does not tolerate the mask then use the mask as blow by, monitor and rapid transport. Definitely not something you run into every day. Interested to see what the correct answer is.
  12. The monitor is telling me 120-155 (went up and down during the short transport). I believe what I palpate would be more significant, but am unsure of myself. Just because each of those ventricular contractions is not producing enough ejection to produce a palpable pulse, does not mean those beats are putting out nothing. So to me it seems both are significant, but the peripheral pulse would be more important because obviously what you feel is the beats that are producing more blood flow.
  13. So I am finished with paramedic school and doing my last ride outs but still am unsure about a couple of things that were not taught in class, and do not show up in my book. I want to be able to find things like Left/Right Axis deviation and Pericarditis. Our teacher basically taught us how to find ST elevation and diagnose an MI, but never went over things that could mimic ST elevation like pericarditis. I know that being able to find Right Axis Deviation can help confirm V-Tach in wide Qrs tachy's, so I would like to be proficient in recognizing that as well. I am having trouble finding places to explain this well, and was wondering if anyone knew a good place on the internet, or even a good book that I could look into. I thought about buying Bob Page's book (12-Lead EKG for acute and critical care providers), but don't know if it covers those things as well. Thanks for any info
  14. I was doing a ride out today and had a patient who had chronic A-Fib. His pulse on the ECG was 120-155 or so, and when I palpated a pulse it was much slower. It was hard to calculate due to it being a bumpy ride (every 6-7 beats I'd count we would hit a bump and I would lose it for a couple secs), not to mention the irregularity, but it was around 65-75. I looked this up when I got home and it says its a normal finding in a-fib and just means each ventricular contraction is not producing enough of a pulsation to reach the peripheral points. From what I read its not a significant clinical finding.... but nowhere could I find anything that says which pulse to go off of? To I tell the ED in my radio report his ecg pulse or the palpable one, or just tell them both? Which one is more clinically significant? Thanks
  15. Got a call yesterday saying I did very well in my interview and HR will be contacting me on the next step in the hiring process. So I think I got it, although after I talked to my teacher and another student in my class, the company in unlikely to work with my school schedule, my teacher says he lost a couple student to this company. Apparently they give you a set schedule when you start and are unwilling to work around medic school.... so I may not be able to take the position, we will see I guess. Thanks again for the help everyone.
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